Permit � CITY OF TIGARD PLUMBING PERMIT
7 ! '• COMMUNITY DEVELOPMENT Permit#: PLM2022-00456
Date Issued: 11/8/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S126DC00902
Jurisdiction: Tigard
Site address: 9500 SW GREENBURG RD •
Project: Crown Oaks Apartments Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Replacing 800 ft.of water service.
Contractor: MODERN PLUMBING Owner: OREGON SUNSHINE LLC
11120 SW INDUSTRIAL WAY BY CARPENTER, HARRIET
TUALATIN, OR 97062 15435 SW WOODWIND CT
BEAVERTON, OR 97007
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
800 If Water Service 11/08/2022 $325.18
Specifics: 1 ea Backflow Preventer 11/08/2022 $31.27
1 12%State Surcharge- 11/08/2022 $42.77
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $399.22
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature: /fff '
ref
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities FOR OFFICE: USE ONLY
City of Tigard PemdtNc.:
13125 SW Hall Blvd,Tigard,OR 91223 R EC F l\ pie view J//'/p �_
1111 I Phone: 503,718.2439 Fax: 503.598,196D �, Datei9y: Other Permit No.:� l6y'
Ins ction Line: 503.639.4175 ^!n��
i k i i.tt i> Pe l' Date ReadylBy: 7mu: 91 See ego 2 lbr
Internet vnvw.tigard-or.gov Notified/Method: SuppkmentalInformation
77'PE`OF-W01iiC ''Ui i' 1 lli - ;FEE" SCHEDULE
'' i1ir-f'INf fli\I' Fhb Forspec►al►t{►brntretlsuuseci mis6
❑New construction 0 Demo t o
�, Description I Qty. I Ea. I Total
❑Addltioitlalteration/replacemcnl $Other: �v(w)(a'ti OP New 1-2-family dwellings(includes 100 ft.for each utility connection)
;: CATEGORY OF:CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building %Muiti-family Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMp.TJON AND.:LOCATION Site utilities:
Job site address: 9 7O 51A) ,�c - ,e Cetchbnsin or area drain 18.76
/ Drywall,leach line,or trench drain 18.76
City/State/ZIP:7 qp e-ds Dia R 7 z fi`7j Footing drain(no.linear ft.:, ) Page 2
Suite/bldg.apt.no.: I Project name:9:5,0O 6At eete,2i Manufactured home utilities 50.03
Cross street/directions to Job site: Manholes 18.76
Ffr�1,j,ta1 r�.`7 1, AA/''�„a,s_�.y H n Rain drain connector 18.76
l /`m�M (c49 Nall .iv4• sanitarysewer(no.linear lt.: ) Page
1/'�" Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: OQ) Paget , ,)5 us-
Subdivision: I Lot no.: Fixture or item;
Taxmap/pareelno /S /1,‘• ,bG r9v?a2 R2_4.430 , Backflowpreventer /1 31.27 3 i 4)-7
DESCRIVI ION OF WORK Dcekwater valve 12.51
Clothes washer 25.02
aAiS I w i,/, 10 building Dishwashe
r her 25.02
CVx E I 1.c) Drinking fountain 25.02
l//i I LYYV7tle- ,F-444''�.e_ e_e �•i,�.t A?„t,�iectora/sump 25.02
P1tOPERTY OWNER "`; [Q...4**NT T":: _Expansion tank 12.51
ll/l ,
Name: W S A k,,(_(r ^ Fixture/sewer cap 25.02
l7 Floor drain/floor sink/hub 25.02
Address. I_ (7 f(("/ 1144 rs, 4-L-- `1l' Garbage disposal 25.02
City/State/ZIP: l'Ol_TL.9N/�Oi& 7 ZO`7 Hose bib 25.02
Phone:(%1) K� 0z2p Fax (. 93) v}v' C Z-c/l Ice maker 12.51
APPLICANT[ Gi CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: /5790 a,e-rz",v/ rF/
7 Primer 12.51
Contact name: :�f.Ff+ rfr5.fpxn&r- Roof drain(commercial) 12.51
Address: /y(7 Ml u ma rs44-4 e. Sr Sink/basin/lavatory 25.02
City/StatelZIP: for_i//,7c4 O/i? f 7 ZD 9 Solar units(potable water) 62.54
Phone:(p3) 7 02 ) 3 s Fax:;( z 1150 p Z-91 Tub/shower/shower pan 12.51
E-mail: rp A Lt/es 6�ty - C".vt; urinal zs.D2
+�F Water closet 25.02
CON7IA.CIOR Writer heater 37.52
Business name: 0-1 //� /`�_ Water piping/DWV 56.29
Address: ///2) s't.J_..1 W�7 );9I-%t-� Other: 25.02
''�7I'O Subtotal 3y6,('(15
City/Stale/ZIP: (ti W U �( - � _
/ vim` --/ / Minimum permit fee: $72.50
Phone:I pal f ,- Fax:' _
' ' - -�'�r�G/ Plan review (25%of permit fee)
CCB Lie.: 677 e Plumbing Lie,no.:, -p 4�
� i State surcharge(12%of permit fee) - /
Authorized signature: �„�.. TOTAL PERMIT FEE ,„_.
Print name: f¢ /1-i ./ C'j y, Date: !/'///' This permit application expires if a ptrmit is not obtained within t dole
• G anon it has bier accepted as complete.
*Fee methodology sot by Tri-County Building Industry Service Board.
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Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule Residential Fire Suppression Systems:
Site. Jtilities ' Qly Fee Yea) Total Square Footage: Permit Tree:
Fooling drain-I"100' 50.03 0 to2,000 $121,90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-Eat 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
WaterService-enehadditiatal 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Yee:
Stoma&Rain Drain each additional 100' 37.52 $1.00 to$5,000.00 Minimum fee$72.50
$5,001.00 to$10,000,00 $72.50 for the first$5,000A0 and$1.52 for
Other.Inspections or Fees. QIY ::Fee(Cu) rolai each additional$100,00 or fraction thereat to
Inspection of existing plumbing or for and including the IOst$10,.
which no fee is specifically indicated 90.00/hr
$10,001.00 to$25,000.00 each a 0 for first$/0,000.0 t and$1,54 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business gp,pp and including$25,000.00.
hours(minimum charge—2 hours) $25,001.00 to$50,000.00 each a 0 fortithe first$25,000.00 and$1.45 for
Reinspeedon Fees 9p ppmr each additional$100.00 or fraction thereof,to
and including e
Additional plan review for revisions 90.00/hr $50,001.00 and up first$50,000.00
.00.
.2D for
(minimum charge--112 hour) each additional$0.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Tyne • flan Review for: lumb ngini tallations.Fixture Type for • Re yam/,
Work Pcrlornted. Capps Aunt. . Ililomts r' plan review is required for any of the following,
Baptistry/Font Please check all that apply.
Bath Tub/Shaver ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918.780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780.0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4" Isotric or Riser Diagram
Car Wash Drain " me $
Garbage Domestic•non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer Increase must be paid before the
Urinal plumbing permit can be issued,
Other Fixtures:
I:1IIuildinglPermitslPLMU PermitApp.doe 2